What to Expect From a Physiotherapist's Walking Assessment

Why a physiotherapist, and when

A physiotherapist is trained to assess how the body moves and to treat problems of movement. For an older adult they can find out why walking has become difficult, choose and fit the right aid, teach safe technique and design an exercise plan. They look at the whole person: strength, balance, joints, pain, breathing, medicines and home, not only the legs.

Ask for an assessment when:

• your parent has had a fall or a near fall;
• they have started to reach for furniture or avoid going out;
• they are recovering from surgery, a fracture, a stroke or a long illness;
• they have a new condition such as Parkinson's disease;
• they use a walking aid that no one has checked; or
• you are not sure which aid to buy.

A geriatric physiotherapist or one with experience in neurological or orthopaedic rehabilitation is ideal. Assessments can happen in a clinic, a hospital or at home. A home visit is better for older adults, because the physiotherapist sees the real environment: stairs, doors, floors, bathroom and lighting.

Before the visit: how to prepare

• Write down your concerns. When did the problem start? Has there been a fall? What does your parent find difficult?
• List medicines and bring or photograph the strips and prescriptions. Some medicines affect balance.
• Bring reports, such as discharge summaries, scans and notes about conditions like diabetes, Parkinson's disease or heart problems.
• Ask your parent to wear comfortable clothes and the shoes they normally use, plus any glasses or hearing aids.
• Bring current aids, such as a stick or walker, so they can be checked.
• Plan who attends. A family member who knows the history is helpful, and with your parent's permission they can hear the advice.
• Allow time. A thorough assessment takes 45 to 60 minutes.

The conversation: history and questions

The physiotherapist will start by talking. Expect questions such as:

• What problems do you notice when you walk, stand or turn?
• Have you fallen in the past year? How, where and what happened?
• Do you feel dizzy, light-headed or unsteady?
• Do you have pain, stiffness or weakness? Where?
• Are you afraid of falling? Do you avoid activities?
• What medical conditions do you have, and what operations have you had?
• What medicines do you take?
• How is your eyesight and hearing?
• What do you do in a normal day? What would you like to do?
• What is your home like: stairs, steps, bathroom, bedroom, lighting?
• Who lives with you and helps?

Honest answers matter. Many older adults downplay falls out of embarrassment, so families can help by gently supplying detail.

The physical tests

The physiotherapist will observe and test, usually in this order. None should be painful.

Posture and standing. How your parent stands: upright or stooped, symmetrical or leaning, steady or swaying.

Standing up from a chair. They may be asked to rise from a standard chair without using their arms, sometimes five times as fast as they can (the five-times sit-to-stand test), which measures leg strength and balance. Needing arms, or being slow, signals weakness.

Timed Up and Go. Your parent stands from a chair, walks three metres, turns, walks back and sits, while the physiotherapist times it. Taking more than about 12 to 14 seconds is associated with a higher risk of falling in older adults, though the exact cut-off depends on age and condition.

Balance tests. Standing with feet together, then in a semi-tandem or tandem position, and sometimes standing on one leg, with eyes open and sometimes closed. These show how well the body holds its position. Your parent will be protected, with a hand close by.

Gait observation. The physiotherapist watches your parent walk, noting speed, step length, width, arm swing, foot clearance, turning, and whether they drag or shuffle. They may ask your parent to walk with and without their aid.

Strength and range of movement. Checks of leg, hip, ankle, arm and grip strength, and of joint movement.

Sensation and feet. Whether the feet feel normal, especially in diabetes, and whether shoes fit.

Blood pressure. Sitting and standing, to look for a drop on standing, which causes dizziness.

Breathing and stamina. Breathlessness on walking, oxygen levels if relevant.

Cognition and following instructions. A brief check that your parent can remember and follow advice, because this affects which aid is safe.

The home check

If the visit is at home, the physiotherapist will also look at the surroundings.

• Floors: loose rugs, polished tiles, thresholds, cables.
• Lighting: dark corridors, switches, night lights.
• Stairs: handrails, step height, visibility.
• Bathroom and toilet: grab bars, non-slip mats, seat height, door width.
• Bedroom: bed height, space for a walker, route to the toilet.
• Furniture: chair height and firmness.
• Door widths: whether a walker or wheelchair fits.

They may recommend changes, such as a grab bar, a raised toilet seat or a night light. For a self-check, see falls risk assessment you can do at home.

What the physiotherapist concludes

At the end they will usually give you a summary: what is wrong, how serious it is, whether your parent is at high risk of falling and what to do. Typical outputs include:

• A recommended aid, with type, height and how to use it. This may be a stick, quad stick, frame, rollator or wheelchair; see stick or walker: which one does your parent need.
• Training in technique for walking, turning, sitting, stairs and doorways.
• An exercise plan for strength and balance, with a few simple moves done daily; see balance exercises for seniors.
• Home changes and equipment.
• Advice on footwear; see walking aids and footwear.
• Referrals, for example to a doctor for dizziness or medicines review, an eye test, a podiatrist or an occupational therapist.
• A follow-up plan, often a review in a few weeks.

Ask for the plan in writing, with pictures if possible.

Questions to ask

• What type of aid is best, and why?
• How should it be set up and used? Can you show us?
• How much weight should be put on each leg, if there is an injury or surgery?
• What exercises should we do, how often and for how long?
• What should we change at home?
• What are the warning signs that mean we should call you or a doctor?
• When should we review the plan?
• How will we know if my parent is improving?

What the assessment cannot do

A physiotherapy assessment is not a complete medical check. It cannot diagnose causes such as heart rhythm problems, anaemia, thyroid disease, medicine side effects or eye conditions, though a physiotherapist may suggest that these be checked. Falls usually have several causes, and the best response combines physiotherapy with a medical review. For a broader approach, see geriatric assessment explained.

Cost and arranging a visit

Physiotherapy fees vary by city, experience and whether the visit is at home. Ask about the fee, what is included, how long it takes and whether follow-up is part of the price. Some insurance policies cover physiotherapy after hospitalisation; check yours. Choose a qualified physiotherapist with a recognised degree and experience in older adults, and be wary of anyone who sells equipment aggressively. Our care advisors can arrange a home physiotherapy visit and help plan equipment.

After the assessment: making it stick

The value of an assessment lies in what happens next. Put exercises in the daily routine, such as after tea or before bed. Fix the home hazards that day. Check that the aid is set up as advised. Ask your parent how they feel after a week; if the aid feels wrong, call the physiotherapist. Keep the follow-up appointment. Over a few weeks you should see steadier walking, more confidence and fewer scares.

When to see a doctor first

Call a doctor urgently if your parent has a sudden change in walking, sudden weakness, numbness or facial droop, new confusion, chest pain, severe dizziness, a head injury or unexplained collapse. These need medical attention before physiotherapy.